A General Assessment of India's Extremely Low Number of Transgender Cancer Patients

PURPOSE/OBJECTIVE(S)

Physiological transgender (TJ) is one of the most marginalized and oppressed community in the Indian subcontinent. The observable percentage of physiological transgender (TJ) cancer patients is extremely low. This concise report aims to assess the factors that contribute to the scarcity of transgender cancer patients.

MATERIALS/METHODS

The hospital database (2012-2021) of 2 centers in New Delhi (population 32 million) & 1 in Kolkata (15 million) were evaluated. In addition, 28 senior oncologists (ONC) and 17 trans women (TWs) completed a six-point questionnaire. ONC was asked how many TJ patients they had seen in their career, as well as histopathology/site. Furthermore, the data was extrapolated to account for all clinicians' cumulative years of experience. The questions for TWs were age and where they go if you have a disease or illness. And, do they know any TJ cancer patients?

RESULTS

India's last census (2011) revealed a half-million TJ population. TJ density must be at least 1 million to be comparable to the rest of the world. Hospital databases counted 10,486 patients, with no patient identified as TJ. A total of 37 TJ cancer patients were reported by 28 ONC with an average and collective years of their medical service of 23.1±4.1 and 646 years; distributed in 3 metropolis of 67 million (combined) population (Kolkata, New Delhi, and Mumbai). The average lifetime number of TJ cancer patients/oncologist was 1.3±1.1. Total 12 cases were head neck cancers, with 4 caused by human papillomavirus. The remaining 25 patients have 5 lung, 5 gynecological, 4 breast, 3 brain cancers, 2 soft tissue sarcomas, and 6 cases of unknown origin. The density of 5-year prevalent cancer cases in India is 0.2%, with an estimated 0.007% of TJ cancer patients. TW could not identify any cancer patients in their community.

CONCLUSION

Being transgender is a social taboo in this part of the world. Their legal rights and classification as the third gender are uncommon. TJs are denied access to standard education, mainstream occupations, and social respect. Although the exact number has never been determined, it is estimated that a large proportion (≈90%) of TJ people are forced to choose roadside begging and working as cheap sex workers. There is no clinical reason why TJs should have fewer cancer incidents, they should be more susceptible to cancer due to unhealthy living conditions, unprotected sex, lack of medical care, proper nutrition, and all other factors associated with their very low socioeconomic status. Nonetheless, it's difficult to find single TJ cancer patients in both public and private hospital OPD. They may be unable to access a traditional clinic due to social discrimination, financial constraints, or they may be unwilling to disclose their true sex. Even TJ's do not show up at free public clinics. The disclosure of true sex may be beneficial in obtaining better treatment, but the more prevalent reason is social unacceptability, which can be overcome through proper education and community economic growth.

CaSR expression in normal parathyroid and PHPT: new insights into pathogenesis from an autopsy-based study

PURPOSE

Calcium sensing receptor (CaSR), on the surface of normal parathyroid cells, is essential for maintaining serum calcium levels. The normal pattern of CaSR immunostaining remains undefined and is presumptively circumferential. Given the physiological variation in serum calcium, we postulated that CaSR expression could not be uniformly circumferential. Also, cytoplasmic expression has not been evaluated either in normal or pathological tissues. We studied normal parathyroid tissues derived from forensic autopsies and those rimming parathyroid adenomas for membranous and cytoplasmic CaSR immunoexpression. Results were compared with primary hyperparathyroidism (PHPT) to look for any pathogenetic implications.

MATERIALS AND METHODS

We evaluated 34 normal parathyroid tissues from 11 autopsies, 30 normal rims, 45 parathyroid adenoma, 10 hyperplasia, and 7 carcinoma cases. Membranous expression was categorized complete/incomplete and weak/moderate/strong; scored using Her2/Neu and Histo-scores; predominant pattern noted. Cytoplasmic expression was categorized negative/weak/moderate/strong; predominant intensity noted.

RESULTS

Normal autopsy-derived parathyroid tissues were Her2/Neu 3 + , but incomplete membranous staining predominated in 85%. Their immune-scores were significantly more than the cases (p <  < 0.05). The mean histo-score of normal rims was intermediate between the two (p <  < 0.05). Cytoplasmic expression was strong in all autopsy-derived tissues, weak/negative in hyperplasia (100%), moderate in 16% adenomas, and 43% carcinomas.

CONCLUSIONS

Normal autopsy-derived parathyroid tissues showed strong but predominantly incomplete membranous expression. Surface CaSR expression decreased in PHPT and is probably an early event in parathyroid adenoma, seen even in normal rims. Whether there is a defect in CaSR trafficking from the cytoplasm to the cell surface in adenoma and carcinoma needs further evaluation.

DNA Supercoiling Drives a Transition between Collective Modes of Gene Synthesis

Transcription of genes can be affected by both biochemical and mechanical factors. Recent experiments suggested that the mechanical stress associated with transcription-induced DNA supercoiling is responsible for the transition from cooperative to antagonistic group dynamics of RNA polymerases (RNAPs) upon promoter repression. To underpin the mechanism behind this drastic transition, we developed a continuum deterministic model for transcription under torsion. In our model, the speed of an RNAP is affected by the local DNA supercoiling, as well as two global factors: (i) the number of RNAPs on the gene affecting the torsional stress experienced by individual RNAPs and (ii) transcription factors blocking the diffusion of DNA supercoils. Our minimal model can successfully reproduce the experimental findings and helps elucidate the interplay of mechanical and biological factors in the collective dynamics of molecular machines involved in gene expression.

Field-theoretic model for chemotaxis in run and tumble particles

In this paper, we develop a field-theoretic description for run and tumble chemotaxis, based on a density-functional description of crystalline materials modified to capture orientational ordering. We show that this framework, with its in-built multiparticle interactions, soft-core repulsion, and elasticity, is ideal for describing continuum collective phases with particle resolution, but on diffusive timescales. We show that our model exhibits particle aggregation in an externally imposed constant attractant field, as is observed for phototactic or thermotactic agents. We also show that this model captures particle aggregation through self-chemotaxis, an important mechanism that aids quorum-dependent cellular interactions.

Testing a Real-Time Tenofovir Urine Adherence Assay for Monitoring and Providing Feedback to Preexposure Prophylaxis in Kenya (PUMA): Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

The worldwide expansion of preexposure prophylaxis (PrEP) with oral tenofovir-disoproxil-fumarate/emtricitabine will be critical to ending the HIV epidemic. However, maintaining daily adherence to PrEP can be difficult, and the accuracy of self-reported adherence is often limited by social desirability bias. Pharmacologic adherence monitoring (measuring drug levels in a biomatrix) has been critical to interpreting PrEP trials, but testing usually requires expensive equipment and skilled personnel. We have recently developed a point-of-care (POC) immunoassay to measure tenofovir in urine, allowing real-time adherence monitoring for the first time.

OBJECTIVE

The goal of this study is to examine a point-of-care adherence metric in PrEP to support and increase adherence via a randomized controlled trial.

METHODS

The paper describes the protocol for a pilot randomized controlled trial to test the acceptability, feasibility, and impact on long-term adherence of implementing a POC urine test to provide real-time adherence feedback among women on PrEP. Eligible women (n=100) will be HIV-negative, ≥18 years old, and recruited from a clinic in Kenya that provides PrEP. Participants will be randomized 1:1 to the intervention of providing real-time feedback via the assay versus standard of care adherence counseling. Acceptability by participants will be assessed by a quantitative survey, as well as by qualitative data collected via in-depth interviews (n=20) and focus group discussions (n=4 groups, 5-10 women each). Feasibility will be assessed by the proportion of women retained in the study, the mean number of missed visits, the proportion of planned urine assessments completed, and messages delivered, while in-depth interviews with providers (n=8) will explore the ease of administering the urine test. Tenofovir levels in hair will serve as long-term adherence metrics. A linear mixed-effects model will estimate the effect of the intervention versus standard of care on logarithmically transformed levels of tenofovir in hair.

RESULTS

This study has been funded by the National Institute of Health, approved by the Kenya Medical Research Institute Institutional Review Board, and will commence in June 2020.

CONCLUSIONS

A novel urine assay to measure and deliver information on adherence to PrEP in real-time will be tested for the first time in this trial planned among women on PrEP in Kenya. Study findings will inform a larger-scale trial assessing the impact of real-time adherence monitoring/feedback on HIV prevention. Improving adherence to PrEP will have long-term implications for efforts to end the HIV epidemic worldwide.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03935464; https://clinicaltrials.gov/ct2/show/NCT03935464.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/15029.

Implementation research for public sector mental health care scale-up (SMART-DAPPER): a sequential multiple, assignment randomized trial (SMART) of non-specialist-delivered psychotherapy and/or medication for major depressive disorder and posttraumatic stress disorder (DAPPER) integrated with outpatient care clinics at a county hospital in Kenya

BACKGROUND

Mental disorders are a leading cause of global disability, driven primarily by depression and anxiety. Most of the disease burden is in Low and Middle Income Countries (LMICs), where 75% of adults with mental disorders have no service access. Our research team has worked in western Kenya for nearly ten years. Primary care populations in Kenya have high prevalence of Major Depressive Disorder (MDD) and Posttraumatic Stress Disorder (PTSD). To address these treatment needs with a sustainable, scalable mental health care strategy, we are partnering with local and national mental health stakeholders in Kenya and Uganda to identify 1) evidence-based strategies for first-line and second-line treatment delivered by non-specialists integrated with primary care, 2) investigate presumed mediators of treatment outcome and 3) determine patient-level moderators of treatment effect to inform personalized, resource-efficient, non-specialist treatments and sequencing, with costing analyses. Our implementation approach is guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.

METHODS/DESIGN

We will use a Sequential, Multiple Assignment Randomized Trial (SMART) to randomize 2710 patients from the outpatient clinics at Kisumu County Hospital (KCH) who have MDD, PTSD or both to either 12 weekly sessions of non-specialist-delivered Interpersonal Psychotherapy (IPT) or to 6 months of fluoxetine prescribed by a nurse or clinical officer. Participants who are not in remission at the conclusion of treatment will be re-randomized to receive the other treatment (IPT receives fluoxetine and vice versa) or to combination treatment (IPT and fluoxetine). The SMART-DAPPER Implementation Resource Team, (IRT) will drive the application of the EPIS model and adaptations during the course of the study to optimize the relevance of the data for generalizability and scale -up.

DISCUSSION

The results of this research will be significant in three ways: 1) they will determine the effectiveness of non-specialist delivered first- and second-line treatment for MDD and/or PTSD, 2) they will investigate key mechanisms of action for each treatment and 3) they will produce tailored adaptive treatment strategies essential for optimal sequencing of treatment for MDD and/or PTSD in low resource settings with associated cost information - a critical gap for addressing a leading global cause of disability.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03466346, registered March 15, 2018.

Three-body interactions drive the transition to polar order in a simple flocking model

A large class of mesoscopic or macroscopic flocking theories are coarse-grained from microscopic models that feature binary interactions as the chief aligning mechanism. However, while such theories seemingly predict the existence of polar order with just binary interactions, actomyosin motility assay experiments show that binary interactions are insufficient to obtain polar order, especially at high densities. To resolve this paradox, here we introduce a solvable one-dimensional flocking model and derive its stochastic hydrodynamics. We show that two-body interactions are insufficient to generate polar order unless the noise is non-Gaussian. We show that noisy three-body interactions in the microscopic theory allow us to capture all essential dynamical features of the flocking transition, in systems that achieve orientational order above a critical density.

Elevated plasma ferritin in elderly individuals with high neocortical amyloid-β load

Ferritin, an iron storage and regulation protein, has been associated with Alzheimer's disease (AD); however, it has not been investigated in preclinical AD, detected by neocortical amyloid-β load (NAL), before cognitive impairment. Cross-sectional analyses were carried out for plasma and serum ferritin in participants in the Kerr Anglican Retirement Village Initiative in Aging Health cohort. Subjects were aged 65-90 years and were categorized into high and low NAL groups via positron emission tomography using a standard uptake value ratio cutoff=1.35. Ferritin was significantly elevated in participants with high NAL compared with those with low NAL, adjusted for covariates age, sex, apolipoprotein E ɛ4 carriage and levels of C-reactive protein (an inflammation marker). Ferritin was also observed to correlate positively with NAL. A receiver operating characteristic curve based on a logistic regression of the same covariates, the base model, distinguished high from low NAL (area under the curve (AUC)=0.766), but was outperformed when plasma ferritin was added to the base model (AUC=0.810), such that at 75% sensitivity, the specificity increased from 62 to 71% on adding ferritin to the base model, indicating that ferritin is a statistically significant additional predictor of NAL over and above the base model. However, ferritin's contribution alone is relatively minor compared with the base model. The current findings suggest that impaired iron mobilization is an early event in AD pathogenesis. Observations from the present study highlight ferritin's potential to contribute to a blood biomarker panel for preclinical AD.

The clinical utility of cycle of threshold value of GeneXpert MTB/RIF (CBNAAT) and its diagnostic accuracy in pulmonary and extra-pulmonary samples at a tertiary care center in India

BACKGROUND

There are knowledge gaps in the in-depth analysis of the most promising and robust diagnostic tool, GeneXpert MTB/RIF (CBNAAT). The cycle of threshold (CT) value of the CBNAAT test and its clinical implications has not been explored much.

AIMS AND OBJECTIVES

The study aimed at (a) estimating the diagnostic accuracy and incremental yield of Xpert MTB/RIF in various specimens (b) establishing the association between CT value category (high, medium, low, very low) and culture time-to-positivity (TTP).

METHODS

A total of 1000 samples, both pulmonary and extra-pulmonary were collected from presumptive TB cases in a large tertiary care hospital. Sensitivity and specificity of CBNAAT was calculated with culture as the gold standard. The association of CT value with culture TTP was also studied.

RESULTS

The overall sensitivity of CBNAAT was 88.5%, with bronchial washing specimen being the most sensitive (92.3%) and pleural fluid being the least (66.7%). In smear negative individuals, the sensitivity of CBNAAT was 80.9%. The additional yield of CBNAAT over smear microscopy was 10.9%. It was observed that as we move from high to very low CT category, culture positivity decreases significantly (p<0.001), whereas time taken for culture growth increases (p<0.001).

CONCLUSION

CBNAAT is a robust test for accurate diagnosis of tuberculosis both pulmonary and extra-pulmonary, smear negative as well, especially in resource-limited settings. The correlation between CT value and culture TTP has potential in predicting bacillary load, though further studies are required.

Association of Ambient Air Quality with Male's Pulmonary Function in Kolkata City, India

BACKGROUND

Kolkata is one of the polluted metropolitan cities in India where health effects of air pollution are raising serious concern.

OBJECTIVES

Purpose of the present study was to analyze association between levels of air pollutants and pulmonary function of adult males living in two different air pollutant zones of Kolkata.

METHODS

Air pollution data of two ambient air quality monitoring stations located at Rabindrabharati and Victoria Memorial was collected from West Bengal Pollution Control Board, Kolkata for the period from January to March 2012. Study was conducted on 200 males (17-22 yrs), subdivided into two groups from living within 3 km radius of that two monitoring stations. They were investigated for their spirometric lung functions following method and technique recommended by American Thoracic Society. Results were expressed as mean ± SD and independent samples T test was conducted to compare between groups.

RESULTS

PM10, SO2 concentrations were significantly higher in Rabindrabharati zone, whereas no significant differences were noted in NO2 and CO concentrations though values were higher at Rabindrabharati than Victoria Memorial. FVC, FEV1, FEF25-75%, MVV were significantly lower in males of Rabindrabharati zone.

CONCLUSION

Exposure to high air pollutant concentration might be associated with reduced pulmonary function in adult males.

pH-dependent size and structural transition in P123 micelle induced gold nanoparticles

The transition of the structure and size of AuNPs at a pH value around 9.5, from slowly grown, well-faceted, large (≫19 nm), less uniform and near connected to fast grown, near symmetrical, small (<19 nm), more uniform and well-separated, is observed.

Malignant Leiomyoblastoma: An Incidental Diagnosis

DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11147   Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 55-56

Diagnostic dilemma in histopathology report following robot assisted laparoscopic prostatectomy: tumour 'hide and seek'

INTRODUCTION

Widespread PSA (prostate specific antigen) screening has resulted in stage migration of prostate cancer. Smaller tumor volumes are being detected in radical prostatectomy specimens. This has coincided with increasing reports about the 'vanishing cancer phenomenon.'

AIMS

To analyse the cases of robot assisted laparoscopic prostatectomy (RALP) at our institute in which the pre operative prostate biopsy was positive for adenocarcinoma but no tumor could be identified in the final histopathology, and to review the literature for possible reasons for such a phenomenon.

MATERIALS AND METHODS

Nine patients were identified out of a total of 184 cases of RALP in which the final histopathology did not correlate with the initial biopsy report. The initial biopsy slides as well as the final histopathology slides were reviewed by a second pathologist. The specimens were processed in entirety and additional sections were taken until no tissue was left.

RESULTS

Two patients had cancer diagnosed on TURP (transurethral resection of prostate) chips, while the remaining patients had undergone TRUS biopsy for elevated PSA. The final histopathological diagnosis was benign prostatic hyperplasia in two patients, chronic prostatitis in four patients, and acute florid prostatitis in one patient, granulomatous prostatitis with glandulostromal hyperplasia in one patient and TCC (transitional cell carcinoma) of prostate in one patient.

CONCLUSION

Most cases of pT0 are due to inability of routine histopathological analysis to identify minute tumor focus. Urologists need to be aware of this in view of the potential medico legal implications.

Atlantoaxial rotatory fixation in a case of tubercular lymphadenitis

Atlantoaxial fixation is a relatively rare cause of torticollis which may be easily missed in practice. Early diagnosis is important as this indicates a compromised atlantoaxial complex with the potential to cause neural damage or even death. Here, we report a case of atlantoaxial rotatory fixation in a 13 yr old male with torticollis for two years and history of defaulting treatment for tubercular lymphadenitis. In this case, the odontoid peg view revealed asymmetric distance between the odontoid and lateral mass of atlas which was confirmed with Fluoroscopy and Computed Tomography (CT) scan. Magnetic Resonance Imaging (MRI) was also done which showed hyperintensity in alar ligaments with posterior inclination of the odontoid peg along with cervical lymphadenopathy.

A Global Electricai-Optical Model of Thin Film Solar Cells on Textured Substrates

In order to simulate the performance of the present day state-of-the-art multijunction solar cells in its entirety, an integrated electrical-optical model has been developed. The one-dimensional ab initio electrical model for the analysis of the transport properties of such devices can handle a very general semiconductor device structure where the material properties vary with position and the gap state properties with position and energy. The original semi-empirical optical model used takes into account both specular interference effects, and diffused reflectances and transmittances due to interface roughness. The latter are derived from angular-resolved photometric measurements and used as input parameters to the numerical programme. Comparison of the illuminated current density-voltage (J-V) characteristics, calculated on the basis of (a) a simple exponential absorption law and (b) the optical model, reveals an increase of ˜1 mA cm−2 in the short-circuit current and ˜8% in the cell conversion efficiency for case (b). Also the long wavelength quantum efficiency (QE) shows a marked improvement, while the blue QE decreases since proper account is taken of the absorption in the transparent conducting oxide and reflection from the device. The combined model is being applied to simulate the characteristics of wideband-gap-emitter-layer solar cells deposited in a three chamber conventional glow discharge reactor onto (i) highly textured SnO2 and (ii) weakly textured indium tin oxide substrates. The cells have been characterised experimentally by J-V and QE measurements. Preliminary results indicate that the integrated model matches the experimental J-V and QE data with a more realistic set of material parameters as compared to case (a).

Gastrointestinal stromal tumours: a clinico-radiologic review from a single centre in South India

Gastrointestinal stromal tumours (GISTs) are rare tumours but are the commonest mesenchymal neoplasms in the gastrointestinal tract. To our knowledge, there is no large case series in Asian countries in which a clinico-radiological descriptive analysis of these tumours has been carried out. In this retrospective study, we analysed our experience of 70 patients with histopathologically proven GISTs, who were presurgically investigated by using CT, and describe the demography, anatomical distribution, imaging features and clinical course of the GIST. We found an unusually large predominance of males in our study, stomach and small bowel appeared to have been involved similarly and small bowel tumours had a higher rate of metastases. We also highlight some unusual CT features of these tumours that we encountered during the study, such as the presence of metastatic lymphadenopathy and satellite nodules, relapse in appendices epiploicae of the bowel, metachronous liposarcoma, adrenal and lung metastases, multiplicity of lesions and aneurysmal dilatation of the bowel. Two of our patients also had multiple neurofibromas, whose association with GIST has been seen in earlier reports. To the best of our knowledge, this article presents one of the largest series of articles on GISTs, to date, in Asian countries. We conclude with a differential diagnosis of GIST, with salient features distinguishing each entity.